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Ann Rheum Dis. 2017 Sep;76(9):1544-1549. doi: 10.1136/annrheumdis-2016-210973. Epub 2017 Apr 11.

Stroke in systemic lupus erythematosus: a Swedish population-based cohort study.

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Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Stroke Research Network at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden.
Department of Health Research and Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, California, USA.
Department of Medicine, Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, California, USA.



To study the occurrence of ischaemic and haemorrhagic stroke in systemic lupus erythematosus (SLE) compared with the general population by age, sex and time since SLE diagnosis METHODS: Adults with incident SLE were identified from the Swedish National Patient Register (NPR, n=3390) and general population comparators from the Total Population Register were matched on age, sex and county (n=16730). Individuals were followed prospectively until first of death, December 2013, emigration or incident stroke (identified from the NPR, Cause of Death Register and the Stroke Register). Incidence rates, rate differences and HR were estimated comparing SLE with non-SLE. Estimates were stratified by sex, age and time since diagnosis.


We observed 126 strokes in SLE and 304 in the general population. Individuals with SLE had a twofold increased rate of ischaemic stroke compared with the general population (HR 2.2; 95% CI 1.7 to 2.8). The HR for intracerebral haemorrhage was 1.4 (95% CI 0.7 to 2.8). There was effect modification by sex and age, with the highest HRs for females and individuals <50 years old. The HR for ischaemic stroke was highest in the first year of follow-up (3.7; 95% CI 2.1 to 6.5).


The relative risk of ischaemic stroke in SLE was more than doubled compared with the general population, and importantly, the highest relative risks were observed within the first year after SLE diagnosis. Thus, the first encounter with patients presents an opportunity for rheumatologists to screen for risk factors and intervene.


cardiovascular disease; epidemiology; systemic lupus erythematosus

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